Detox Option #2: Methadone to Suboxone
From what I had been told in the past by different people, doctors, and websites, suboxone (buprenorphine) is a much more effective drug than methadone when it comes to treating opiate addiction and ultimately being able to take yourself off of opiates altogether. Furthermore, suboxone is often described as being more ‘clean’ than methadone and I have been told by two different doctors, one of them being a pain specialist, that he has witnessed miracles with patients that successfully used suboxone to relieve themselves of opiate addiction and most cases that he has known are still clean to this day.
After a while, it occurred to me that my best bet to get clean might be through suboxone. If I did it this way, I would essentially switch over from methadone to suboxone and then ween off the suboxone after a relatively short period of time, gradually tapering down, until I am completely off of medication. Supposedly, the withdrawals from suboxone would not be as bad.
Now, I might get some heat for this one, but when I thought of switching from methadone to suboxone, something else came to mind. It is widely accepted that hydrocodone (Vicodin, Norco, etc) withdrawals are less severe than methadone withdrawals. The intensity of withdrawal from hydrocodone might be greater, but the duration of withdrawal symptoms can be between a few days and a week, which is nothing compared to methadone withdrawals that can last months. Obviously, if a methadone user took hydrocodone instead of methadone one day, they would not have withdrawals, but it would also require 2-3 doses during the day because their body is used to methadone which is an opiate working 24/7 in their body. If a methadone user switched to hydrocodone, let’s say, for two months, with the second month being a taper, would it be safe to conclude that this person would be subject to a shorter duration of withdrawals than they would be on methadone? I would appreciate feedback on this one because once again I want to note that it is only speculation on my part.
But to get back on subject here, let’s examine how a person on methadone could switch to suboxone and what would their experience be? I will break this down in to five parts. (1) What is suboxone? (2) How would I get suboxone? (3) When and how do I start taking suboxone? (4) How effective is suboxone with treating opiate addiction? (5) Will I consider going from methadone to suboxone?
Part 1: What is suboxone?
First off, this is where I have to remind you that I am a dummy when it comes to science, so please bear with me an I attempt to describe it as accurately as possible and if I make any mistakes, please leave a comment below the article and correct me! Suboxone is an opiate antagonist. That means it is used to block the effects of opiates by working on the opiate receptors in the brain. There is no high or euphoria from taking suboxone and because of the way it blocks opiate receptors, if a person taking suboxone tried to take any other opiate, this medication would prohibit that other drug from binding to the opiate receptors and thus, there would be no effect (or point) from taking other opiates while on suboxone. This is precisely the reason that someone should never take their first dose of suboxone until all other opiates are completely out of your system. I will discuss that further in Part 3 below. The generic name for suboxone is buprenorphine and other forms of suboxone include subutex, temgesic, amd buprenex.
Part 2: How would I get suboxone?
Here is where it starts to get tricky. Suboxone is not one of those drugs that you can get from your primary care physician by walking into their office and telling them you want to get off of opiates. You would need to find a doctor in your area by using the suboxone doctor locator tool at suboxone.com. On the right sidebar there is a small box to enter your zip code and bring up a list of participating doctors in your area. At the very least, participating doctors will require an often expensive consultation and some will require that you enroll in a program with therapy and monthly visits. Each visit will normally cost around $100 at the very least. Unfortunately suboxone is not covered by insurance. In January 2012, I actually pursued suboxone treatment, paid $150 for a consultation with a doctor in my area that included a written one month prescription to suboxone and when I took that prescription to the pharmacy, they charged me $350 to get the prescription filled. So that is where I stopped and ultimately I kept on with my cheap methadone prescriptions. Here’s the thing. Had I decided to fill my first prescription for suboxone, I would have paid a total of $500 just for a one month supply and then I would have had to do the same thing again next month. That said, suboxone treatment is known to be very, very expensive, BUT I have read about some individuals that were able to obtain suboxone from doctors at a much cheaper price. All I have to say about that is, visit suboxone.com, get a list of local doctors in your area, and call around. Who knows? You might get lucky and find a deal in your area that is much better than the best one I could find. If you have information on how to legally obtain suboxone at a cheaper price than what I’ve described please e-mail me directly. If I find anything, I’ll post it here too.
Part 3: When and how do I start taking suboxone?
A person that has been taking methadone for any period of time must wait approximately three full days from the last dose of methadone before they start taking suboxone. This part is critical and there are no shortcuts, no if’s and’s or but’s around it, you must wait until methadone is out of your system and you are experiencing severe withdrawals before you take that first dose of suboxone. If you do not wait this period and decide to take suboxone earlier, you will feel even worse and more importantly, the suboxone won’t work as intended. And now you are wondering why? This is the part I hate because I have to attempt to give you a scientific explanation which is something that often makes me look like a complete idiot, but this is important enough, so here we go. You need to wait until your opiate receptors are completely void of methadone so that the suboxone is able to fully bind to the receptors and start doing its job. Since methadone remains in your system longer than any other opiate, it is critical to wait this period of time, no matter how unpleasant the withdrawals are during this time. What happens if you take suboxone just one day after your last dose of methadone? The suboxone will unnaturally knock off any remaining methadone from the opiate receptors, and you will be forced into even more intense withdrawals with the suboxone possibly going to waste. There is something called the “COWS” worksheet that can tell you whether or not you have waited long enough to take the first dose of suboxone. Click here to view or download the COWS worksheet and if you are considering taking suboxone in the future, please save the PDF file to your computer (File > Save As in your web browser) because it will come in handy when the time comes. After the questionnaire, the COWS worksheet also provides excellent professional information about suboxone, precipitated withdrawals, and avoiding precipitated withdrawals by taking suboxone as intended. The second page also explains how long a person must wait depending on what opiate they were taking previously. For example, if a person is taking short-acting opiates (Vicodin, Percocet, Norco, Oxycontin crushed or insufflated, Heroin) they would have to wait between 12-24 hours to take suboxone for the first time. But if the person takes long-acting opiates (Oxycontin orally or methadone) then you wait longer. With methadone, a score of 5 on the COWS worksheet indicates the person is ready to take suboxone. Typically, it would take between 36 and 96 hours (or more) to score 5 on the COWS worksheet. Yes, this is going to be a long time off of methadone before you can take suboxone, but it is better than the potential months you would have to experience withdrawal symptoms otherwise. Furthermore, if suboxone gives you a greater chance of recovery and withdrawal effects are much less severe than with methadone, this instantly becomes a viable option for all of us, if we can find an affordable option.
Part 4: How effective is suboxone with treating opiate addiction?
Alright, now we finally cut to the chase. A moment ago I stated that if withdrawals from suboxone are much more manageable than withdrawals from methadone, then it is an option worthy of your strong consideration. But if we look at individuals that have attempted the transition from methadone to suboxone, does that ring true? There are mixed opinions here. There are people that will say “Well, if you have already gone through methadone withdrawals for three days before taking suboxone, just stick to it! Because you have already gone through the worst of the withdrawals and it will only get better from there, right?”. In my own experience, I would have to say that this isn’t true. Fortunately I can speak from the perspective of someone who once quit methadone cold turkey, and I can tell you first-hand that by no means was I clear from the worst of the withdrawal symptoms after three days. The withdrawal symptoms persisted for much, much longer than that. But nonetheless, there are people that make this point, and I suppose it is valid. Especially because through my research I have determined that withdrawal from suboxone is by no means “easy street”, but it might be a little more manageable than methadone withdrawals. I have found a wonderful article written by an individual that has taken both methadone and suboxone and also compares the two drugs in two sets of helpful tables. One of the statements that grabbed my attention: “Most of the stories about individuals coming off of Suboxone pale in comparison with coming off of methadone cold turkey” (Source). One thing I would point out about this site is the “severity of withdrawals” for each drug. It describes methadone as “severe” and suboxone as “mild-severe” and from my research, that seems to be an extremely accurate description of the two in comparison. Suboxone withdrawals are not easy at all from what I am reading, but there are former heroin addicts that have stated their withdrawals from suboxone were nothing compared to heroin. In contrast, I have read about heroin addicts that stated withdrawals from methadone were more difficult than from heroin. So the last two sentences would be a helpful way for you to compare and contrast the two. It is also recommended that a suboxone patient should stay on the drug for about eight weeks and then go to battle with the withdrawals. If there is one good thing to say about the high cost of suboxone, it would certainly give me reason to want to stop using it as soon as I possibly can just for the sake of saving money! It is good to hear that long term use of suboxone is not recommended. After all, the longer you stay on suboxone, the more difficult it will be to get off of it. Then I found a link from a message board with seven pages of real life suboxone withdrawal experiences. Now we cut to the chase and read about a lot of people that seem to share shockingly similar stories about suboxone withdrawal. Like methadone withdrawals, in most cases the duration of suboxone withdrawal is long and intense. I am sorry that I can’t sugar-coat it and tell you what we all want to believe, that suboxone withdrawal is a hell of a lot easier than methadone withdrawal, but it does seem slightly more manageable and the chance of relapse seems to be lower, which is important to note. Ultimately, I would have to use the cliche that withdrawal experiences will “depend on the person” and how strong they are, but someone that is strong enough to get through withdrawals would get through it the same whether it is with methadone or suboxone as far as I can tell. That said, I would still leave you with this in the end. If former heroin addicts generally tell us that suboxone withdrawal is more manageable than heroin withdrawals, but methadone withdrawals are less manageable than heroin withdrawals, there seems to be a fair amount of evidence that suggests suboxone withdrawals are at least a little less severe than methadone. Now, if you made it this far in my analysis, I apologize if I have left you more confused about this subject than where you started, but my conclusions here are as follows:
1) Suboxone withdrawal can be intense, but slightly less severe than methadone withdrawals. Do not be mislead in to assuming that it will be that much easier to cope with than methadone withdrawals.
2) Let the real life experiences with suboxone speak for themselves. Again, I would highly, highly recommend reading this message board thread with 7 pages of real suboxone experiences speak for themselves if you have been thinking about taking suboxone.
Part 5: Will I consider going from methadone to suboxone?
At this point, I would have to say No to suboxone. To me, the cost does not justify the results after reading these experiences. That said, if the cost of methadone and suboxone were the same, I would choose suboxone because withdrawals seem to be slightly more manageable with suboxone. I would also say that although I am saying “No” at this point, if I cannot find a better option by the end of my studies, I will have no choice but to reconsider suboxone and revisit the doctor locator tool at suboxone.com to find the most affordable prices in my area. In the meantime, keep an eye on the Success Stories section of the site because when I begin to populate that section, I am sure I will still find a few inspiring stories from inspiring people that have used suboxone to rid themselves of opiate addiction.